Pneumatic Vitreolysis for Vitreomacular Traction

In this interview from AAO 2016, Dr. Clement Chan discusses a technique he introduced more than 20 years ago: the use of intraocular gas to induce a posterior vitreous detachment to relieve vitreomacular traction (VMT). Though early adoption was slow, interest is beginning to grow. Dr. Chan says his technique is more effective and less expensive than ocriplasmin (Jetrea, ThromboGenics) and less invasive than vitrectomy. His pilot study published in Ophthalmology in 1995 showed a high rate of VMT release (94.7%) along with a 50% closure rate in small, stage-2 macular holes. The simple procedure is conducted in an outpatient clinic. After sterile prepping and subconjunctival injection of anesthesia, he injects 0.3 cc of C₃F₈ gas. Partial face-down positioning is recommended for patients with stage 2 macular hole. His studies show that the technique works best in patients with VMT limited to 1 disc area, small stage 2 macular holes without extensive vitreomacular adhesion and traction, and in those without diabetes and without thick cellophane membrane.